What your Insurance Company Requires when Submitting your Claim

Podiatric medicine is not included in the Canada Health Act, however most private insurance providers include podiatric services in their coverage. Though claim submission guidelines differ from provider to provider, there are some common requirements that patients should consider upon seeking and receiving the services of a foot care professional. Along with a completed claim form, you should be prepared to satisfy the requirements detailed below.

Proof that the orthotics were paid in full

Your insurance provider will require proof that you have paid for your custom orthotics. Before leaving your foot care practitioner’s office, be sure to ask for an official insurance receipt with the following information:

  • name and address of the provider
  • breakdown of charges for the orthotics
  • date of full payment
  • date of product pick-up

Proof that a qualified professional prescribed Podiatric services

Many insurance providers require that your custom orthotics be prescribed by a healthcare professional as a reasonable treatment for disease or injury. Qualifying professionals often include:

  • Physician, MD
  • Doctor of Podiatric Medicine, DPM
  • Certified Chiropodist, D.Ch
  • Orthopedic Surgeon, ORS

In some instances, the prescription must also include a medical diagnosis.

Proof that a certified foot care professional provided adequate services

Because the distribution of orthotics is generally unregulated, your insurance provider will require proof that you purchased your device from a certified provider. Qualifying professionals include:

  • Doctor of Podiatric Medicine, DPM
  • Certified Pedorthist, C.Ped (C)
  • Certified Chiropodist, D.Ch
  • Certified Orthotist, CO (C)

In addition, you may be required to include the following documentation from your provider:

  • detailed copy of your gait, stance, and biomechanical examinations
  • description of the casting methods used
  • description of the type of orthotic provided, including the materials used in its construction

* Insurance claim requirements differ from provider to provider. Always check with your insurance